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Individual
MAI PHAM NGUYEN
Active
Individual
MAI PHAM NGUYEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
13235
CA
152W00000X
Optometrist
Primary
4511
MA
152W00000X
Optometrist
6559T
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42187
SPECTERA
MA
01
—
MA0451
EYEMED
MA
Enumeration date
02/19/2007
Last updated
05/29/2008
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